RANTS: The NHS

Even before family and friends began pointing out that my postings contained a decidedly pro-European flavour, it had been my intention to balance the score by highlighting a few things the Americans do better than their British counterparts.

Until now, I've refrained from doing so because, as a newcomer, I did not feel qualified to criticize. Also, with the decision to leave my native country such a recent event, I didn't want to convey the notion I was beginning to think, "Oh my God, what have I done!"

After three years, however it's time to let the secret out: there are some things the Americans do better than the British. Healthcare is one.

Sure, the American healthcare system is a nightmare of rules, insurance regulations, forms and the occasional person falling through the cracks. But in its own, ponderous, wasteful way, it provides one of the best medical care anywhere in the world.

Over here in the worker's paradise, there are no claim forms to fill in or any rapacious insurance companies to worry about. The health system is run by the government, not business; and therein lies the fatal flaw.

Businesses do not care about people, they care about profit; but people provide that profit and if they treat people badly the people will put their money into a business that treats them better. This keeps American healthcare at least acceptable. Governments do not care about people, but they do not care about profits, either; they care about numbers that show what a good job they are doing, which is why the National Health Service provides such abysmal service.

Let me, at this point, state emphatically that this is not an indictment of the healthcare professionals. Over here, especially, where becoming a nurse or a doctor means a life of civil servitude, people who choose these professions are dedicated to helping people. They are not in it for the money; their lot is to provide the best care they can despite government meddling and under funding and they do so, for the most part, with a dignity and courage I couldn't hope to match. The true culprit here is the government, and the notion that socialized medicine could ever be anything other than a fiasco.

Governments adore bureaucracy, so they will under staff, under fund and under pay before cutting out redundant layers of managements. The result being that my doctor is allowed to see each patient for only ten minutes. During my one visit--for my tinnitus--I explained that my doctors in America had been tracking my hearing loss and I was hoping to pick up where they left off. The harried man could do nothing but gape at me in astonishment.

"If you can still hear, what did you make an appointment for? Come back when you need a hearing aid!"

Under such impecunious circumstances, it seems preventative treatments become a luxury they cannot afford.

Being an American and not used to such poor service, I stood up, apologized for wasting his time and started toward the door.

"All right," he sighed, I'll send you for a hearing test."

I was to be notified of the test by letter so I looked in the post that next week for my appointment notice.

"I don't why you're expecting it now," my wife said as I shuffled through the mail, "that won't come for months."

True to her prediction, several months later a notice came telling me when and where I was to report. I went, had the test and was told I needed a scan. They gave me a slip of paper and told me to go to the x-ray unit. I fully expected to have it done that day but the woman at the desk simply smiled and told me they would contact me.

That was eighteen months ago.

It's been nearly two years now and nothing has progressed. The 'unofficial' explanation goes like this: there is a time limit for patients to be on 'the list.' This is how the government proves to itself that it is doing a good job, by how long people have to wait for treatment. Once I have a scan, if there is something wrong, I will need to be put on 'the list' for a hearing aid. Once I'm on the list, they have a limited time to deal with me. As long as I don't have the scan, they don't have to put me on the list and they don't have to account for my idle time.

Fair enough. My continually asking my wife, "What did he say?" is not exactly a life-threatening condition; at least not yet. But take note of some other developments I have personally encountered over the past weeks.

In an effort to give the appearance of progress without actually accomplishing anything, the government recently 'reorganized' the health service by closing down local hospitals and creating regional 'major surgery' units. This makes as much sense as 'regionalizing' the fire service by creating one large fire department in Manchester.

Our area is now served, not by the hospital seven miles away, but by a facility in the next county. This 'centre' serves Surrey and West Sussex--both huge counties--and the building itself is a single story structure, taking up less land area than a mid-sized hospital in a small American city.

Ignoring the insanity of trying to serve so many people under such a diminutive roof, simply the time it takes to get there can be lethal. There has already been one report of someone dying in the ambulance because it took too long to get to the hospital.

I had the occasion to visit this hospital not long ago, and was surprised to see ambulances queued up at the emergency entrance. This was because, once they discharge their passengers, they are on 'the list' and that would bring the hospital's averages down. As long as patients remain in the ambulances, the clock does not start ticking.

Inside the hospital, I found walls gouged and scuffed, windows streaked with dirt and tiles missing from the ceilings, exposing pipes and wires. Medical equipment is scarce, inadequate and antiquated and patients are kept in wards--large, often co-ed, dormitory-type rooms filled with people in hospital gowns--which, until then, I thought had gone out of fashion with the hula-hoop. Virulent viruses routinely run rampant through these wards fueled by proximity and poor sanitation.

The friend I went to visit had, rightly, been admitted by his doctor due to an angina attack. He was put in an assessment ward and waited there three days before seeing a doctor. Yes, three days. You would have a better chance of randomly running into a doctor shopping at your local Tesco's.

After finally being evaluated, it was decided he might have to have a shunt inserted. This necessitated transferring him to another hospital even further away because, apparently, a simple procedure like that was beyond the scope of this 'major surgery' centre. There was, of course, no bed available at the distant hospital so the doctor, familiar with the insanity of the system, kept him in the ward even though he was in no immediate danger and could have gone home. The reason was, once outside the doors, he would be off the list, and would have to wait months before getting another appointment. As long as he remained in the hospital, they would have to deal with him, eventually.

The problem was, if he walked around too much, it would be apparent there was nothing wrong with him, so he remained, under virtual house arrest--allowed only to wander up and down the ward--for a week.

Meanwhile, at a major hospital in London, another acquaintance checked in to have a recent hip replacement evaluated. While there, he suffered what doctors thought might be a stroke. Assessing his condition meant moving him to another hospital but, as there were no ambulances available, he was put in a cab, in his pyjamas, and sent across town, by himself, to the other hospital; a man, with a recent hip replacement who had just suffered a stroke. The cabbie was not amused.

To their credit, the government knows the system is a mess, but they have no idea what to do about it. One idea they floated was to have people pay for their doctor visits, treatments and operations. In a land with universal health coverage, to actually receive service, they wanted you to pay for it! You can imagine how that idea was greeted.

The popular notion over here is that, in capitalist American, only the rich see doctors and only 45% of the population actually has insurance, while over here, everyone enjoys free healthcare. More accurately, everyone in America is entitled to heath care, while over here, 100% of the population are denied an adequate health service.